Prostate-specific Membrane Antigen-radioguided Surgery for Metastatic Lymph Nodes in Prostate Cancer
Prostate-specific Membrane Antigen-radioguided Surgery for Metastatic Lymph Nodes in Prostate Cancer
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DOI：
10.1016/j.eururo.2015.04.034
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发表时间：
2015-09-01
期刊：
影响因子：
23.4
通讯作者：
Eiber, Matthias
中科院分区：
文献类型：
--
作者：
Maurer, Tobias;Weirich, Gregor;Eiber, Matthias
随着Ga-68标记的前列腺特异性膜抗原-N，N '-双[2-羟基-5-（羧乙基）苄基]乙二胺-N，N'-二乙酸（Ga-68-PSMA-HBED-CC）正电子发射断层扫描（PET）混合成像在前列腺癌（PCa）中的出现，甚至可以可视化小的转移性淋巴结（LN）。然而，由于其不明显的形态和/或非典型定位，术中检测此类LN可能并不容易。我们的可行性研究的目的是评估PSMA-放射导向手术检测转移性淋巴结。1例原发性PCa和LN转移证据的患者和4例在Ga-68-PSMA-HBED-CC PET混合成像上具有局部LN复发疾病证据的PCa患者在手术前24小时接受In-111-PSMA研究和治疗剂的静脉内注射。术中使用伽马探头结合听觉和视觉反馈跟踪转移性淋巴结。体内检测到的所有放射性阳性LN标本均通过离体测量确认，并根据组织病理学分析对应于PSMA-亲合性转移性疾病。术中使用伽马探头检测到术前Ga-68-PSMA-HBED-CC PET上识别的所有PSMA阳性病变。有助于检测小的亚厘米级转移性淋巴结，2例患者的PSMA放射导向手术显示了术前Ga-68-PSMA-HBED-CC PET未检测到的靠近已知肿瘤沉积物的其他病变。然而，需要更多的患者数量和长期随访数据来确定PSMA放射导向手术的未来作用。(C)2015年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
With the advent of Ga-68-labeled prostate-specific membrane antigen-N, N'-bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine-N,N'-diacetic acid (Ga-68-PSMA-HBED-CC) positron emission tomography (PET) hybrid imaging in prostate cancer (PCa), even small metastatic lymph nodes (LNs) can be visualized. However, intraoperative detection of such LNs may not be easy owing to their inconspicuous morphology and/or atypical localization. The aim of our feasibility study was to evaluate PSMA-radioguided surgery for detection of metastatic LNs. One patient with primary PCa and evidence of LN metastases and four PCa patients with evidence of recurrent disease to regional LNs on Ga-68-PSMA-HBED-CC PET hybrid imaging received an intravenous injection of an In-111-PSMA investigation and therapy agent 24 h before surgery. Metastatic LNs were tracked intraoperatively using a gamma probe with acoustic and visual feedback. All radioactive-positive LN specimens detected in vivo were confirmed by ex vivo measurements and corresponded to PSMA-avid metastatic disease according to histopathology analysis. Intraoperative use of the gamma probe detected all PSMA-positive lesions identified on preoperative Ga-68-PSMA-HBED-CC PET. Detection of small subcentimeter metastatic LNs was facilitated, and PSMA-radioguided surgery in two patients revealed additional lesions close to known tumor deposits that were not detected by preoperative Ga-68-PSMA-HBED-CC PET. However, greater patient numbers and long-term follow-up data are needed to determine the future role of PSMA-radioguided surgery. (C) 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.